Managing Arthritis

Seniors and Medical Cannabis

Senior couple, cleaning up their coffee mugs, chatting

A Q & A with:

Dr. Carolina Landolt-Marticorena, MD, PhD, FRCPC
Rheumatologist, Summertree Medical Clinic & Runnymede Healthcare Centre
Scientific Advisor, MediPharm Labs

Seniors as a patient population are likely to have one or more chronic health issues for which they are taking medication. This presents specific challenges when introducing medical cannabis.  In this article, Dr. Carolina Landolt-Marticorena answers our questions about considering medical cannabis use as a senior.

Are there any risks specific to seniors in using medical cannabis for arthritis symptom management?

The good news is that there are actual studies looking at this question. A review of patients over the age of 65 taking medical cannabis for pain found that for most individuals this was a safe choice. A surprising finding of this study was that patients had a decreased risk of falls. The reason for this is that patients were able to decrease other pain medications such as narcotics which can be associated with dizziness or disorientation.

The takeaway is that most seniors can utilize medical cannabis safely. It does not mean that it is safe or appropriate for all individuals and this is where a discussion with an experienced medical cannabis prescriber is essential. Safety considerations include concerns about interaction with other medications or worsening fall risk or disorientation. 

Are there any known interactions between medical cannabis and other medications seniors might be taking? 

To date there is limited information about potential interactions with other medications as medical cannabis has only recently become widely available to patients. A reassuring point is that no major concerns for most medications have been identified despite the growing number of patients using medical cannabis. The one caveat to this is for individuals on blood thinners, as there is a concern that medical cannabis may increase their risk of bleeding. This is not to say that people on blood thinners shouldn’t utilize medical cannabis, but that they need to make an informed decision about this potential risk.

The bigger message here is that medical cannabis, as with other medications for pain, should be used at the lowest dose that gives relief and that higher doses may not necessarily prove beneficial and may in fact have harmful effects. 

What methods of delivery (inhaling, oils, edibles, etc.) are best for seniors to try?

Selecting a delivery method hinges on a number of factors. Oils or edible have a more long-lasting effect than inhaled products. It’s important to match the method of delivery to the desired effect. For example, an individual with daily chronic pain which disrupts their sleep may opt for the oils or edibles whereas someone who only has pain which flares up on occasion may choose an inhaled product to take only when needed. The key is to choose a product which matches the pattern of pain. Equally important is to select a method of delivery with which the patient feels comfortable and familiar. Many patients will be used to taking capsules or using topical medications but may find the idea of inhaling a medication unappealing. This will certainly impact on the choice of delivery mechanisms. Smoking medical cannabis is not recommended.  Smoking can damage the lungs and worsen pre-existing lung conditions.  Other methods of inhalation include using a vaporizer, vape pen or e-cigarette.

What questions should seniors ask their doctor about using medical cannabis?

This is always an interesting question. Seniors should simply ask if medical cannabis could be beneficial for their condition or might replace other medications they are using for pain or sleep. The responsibility is really on the physician to explore what is driving the patient’s inquiry and to determine if a trial of medical cannabis is reasonable. How did the patient learn about medical cannabis and what are their goals and hopes in pursuing this medication? With the mainstreaming of medical cannabis I find that one of the most important aspects in discussing this treatment with patients is managing expectations. Medical cannabis can be a safe option for pain but it is not a cure-all nor is it effective nor advisable for everyone.

It is not a replacement for medications aimed at treating a chronic conditions such as rheumatoid arthritis. It is simply one more option which patients living with arthritis may find beneficial.

Is there anything else that seniors should keep in mind when considering medical cannabis? 

Over the last 5 years there has been a growing interest in the potential benefits of medical cannabis amongst seniors. With this cultural shift has come a growing comfort in exploring this option and I’ve often seen patients whose family members have purchased products from a legal dispensary for their relatives. Though well-meaning, this is not advisable for a number of reasons. For some patients and their families there is a sense that because a product is “natural” or comes from a plant it is entirely benign. This is not the case. Whether a medication comes from a plant or is manufactured in a lab, they both have the potential for benefit but also side effects. Another area of confusion is product selection and correct dosing. I’ve seen situations where patients are either taking vanishing low doses which are unlikely to be effective or too much with undesired effects. Whenever a patient starts medical cannabis it is always a trial to see if a patient can take this safely and if there is benefit. For this reason it is best to seek out help from a health professional familiar with prescribing and monitoring medical cannabis. They will guide you in selecting the right products, increase your dose as required and watch out for side effects.

For more information, visit the Arthritis Society's Medical Cannabis resources.